Treatment Patterns Differ by Non–Biologic Factors in Undifferentiated Pleomorphic Sarcoma

Treatment patterns differed for patients with metastatic undifferentiated pleomorphic sarcoma (UPS) based on disease characteristics, age, race, combined household income, and treatment facility, according to findings from a National Cancer Database (NCDB) study presented during the 2021 ASCO Annual Meeting.¹

Moreover, multimodality therapy and young age was associated with higher unadjusted overall survival (OS).

UPS is a common subtype of soft tissue sarcoma with significant metastatic potential.

Notably, Hispanic and White patients, individuals over the age of 60, individuals who were on Medicare, and/or those who had a Charlson-Deyo score of at least 2 were more likely to be in the 17.1% of patients who did not receive any treatment for UPS.

Conversely, patients with an annual household income of $63,000 or more, those with private insurance, and those who received care at an academic facility were more likely to receive treatment.

Previously, no large database studies had characterized trends between the clinical and social factors of patients with metastatic UPS and survival outcomes. Investigators in this study used the NCDB to evaluate treatment patterns and OS in patients with metastatic UPS.

“We [wanted] to observe the complex interplay between treatment approaches and non–biologic modifiers,” wrote lead study author Hussain I. Rangoonwala, MBBS, a third-year resident at Creighton University, and her colleagues.

The investigators identified 737 patients newly diagnosed with metastatic UPS from 2004 to 2015 who were part of the NCDB. Investigators evaluated patient demographics including race, ethnicity, gender, socioeconomic factors such as insurance status, annual household income, and education level; geographical factors of care facilities, biologic factors such as the site of metastasis at diagnosis, and comorbidity factors per the Charlson-Deyo score in relation to the type of treatment received.

Treatment types for UPS included chemotherapy (n = 119), chemotherapy plus radiation therapy (n = 53), chemotherapy plus surgery (n = 98), chemotherapy, radiation therapy, and surgery (n = 60); surgery and/or radiation without chemotherapy (n = 271), and other treatments (n = 13). No treatment was also a category (n = 123).

The majority of patients across the cohort were White males with a Charlson-Deyo score of 0.

Survival tables and Kaplan-Meier curves were used to calculate 1- and 3-year survival probabilities. Log-rank analyses were used to compare the variables.

Additional findings from the study showed that patients who received multimodality therapy with chemotherapy, surgery, and radiation therapy had survival probabilities of 56% at 1 year and 26% at 3 years, with a median OS of 15 months. Among patients aged 17 to 30, survival probabilities were 66% at 1 year and 28% at 3 years.

“This is one of the most comprehensive studies involving patients with metastatic UPS that analyzes demographic variables in relation to the treatment approach. Some of the major determinants that influence outcomes in these patients included age, insurance status, treatment at academic facility, [Charlson-Deyo] score, and type of metastases at diagnoses,” concluded Rangoonwala and coauthors.

Reference

1. Rangoonwala HI, Dahl ME, Gootee J, et al. Treatment patterns, and survival of patients with metastatic undifferentiated pleomorphic sarcoma: a National Cancer Database (NCDB) study. J Clin Oncol. 2021;39(suppl 15):11561. doi:10.1200/JCO.2021.39.15_suppl.11561s